Canadians raced to get vaccinated against COVID-19 in the first years of the pandemic, but data suggests there’s far less of a rush to get the latest shots available this fall.
Federal figures show only 15 per cent of the population aged five and up had received an updated vaccine by Dec. 3. And while older age groups had higher uptake rates, more than half of higher-risk older adults still hadn’t gotten a dose by early December, either.
The shots, tailored to the XBB.1.5 Omicron subvariant, are meant to shore up protection against the SARS-CoV-2 descendents currently circulating.
Medical experts say seniors and other higher-risk individuals could leave themselves more vulnerable to serious illness if they skip these updated shots. Less than a third of Canadians in their 60s have had the newest vaccine, along with roughly 44 per cent of people in their 70s, and 48 per cent of those aged 80 and older.
Pandemic fatigue, muddled messaging and complex vaccination timelines might be dissuading Canadians from getting another round of vaccines, experts note.
“Why that gap exists is both an interesting and difficult question,” said Dr. Allison McGeer, an infectious diseases specialist with Sinai Health in Toronto. “I think it’s because people just aren’t getting the message about how much of a risk COVID is.”
Virus still circulating widely
Data shows SARS-CoV-2 is still circulating at high levels across much of Canada, sending hundreds of people into hospital with COVID every week. Weekly rates of hospitalizations and intensive care admissions remain highest among the oldest age groups.
The immune systems of various higher-risk groups — including seniors, pregnant women and people with other serious health issues — can be weaker than those of most healthy adults, increasing their risk of serious illness of any kind.
At the same time, a growing body of evidence suggests that immunity against this ever-evolving virus fades over time, leaving people susceptible to repeat infections.
Just this week, the World Health Organization (WHO) announced yet another variant of interest known as JN.1, an Omicron offshoot that’s rapidly spreading around the world. (WHO officials said the latest batch of vaccines are expected to maintain protection against serious illness and death from this variant as well.)
That’s why updated shots can make a difference, according to Canada’s chief public health officer, Dr. Theresa Tam.
Tam told CBC News there’s “room for improvement” when it comes to vaccine uptake among older Canadians. “That’s the group, of course, that has the highest risk of severe outcomes,” she added.
Close to a third of the country’s older population doesn’t appear to have been infected with this virus yet either, Tam noted.
“They’ve been protecting themselves. They’ve been getting vaccinated,” she added. “But the vaccine base protection can wane over time… even protection against severe outcomes wanes over time.”
That message doesn’t seem to be reaching the public, warned McMaster University immunologist and researcher Dawn Bowdish.
Many Canadians think there’s a “magic number” of vaccine doses that will protect them long-term from COVID, but that’s incorrect, Bowdish said.
While the overall risks of SARS-CoV-2 infections may be lower now than during the early days of the pandemic, fresh shots are necessary while this virus is still “rapidly adapting.”
COVID shots don’t act like many of our childhood vaccines, she explained, since this type of virus operates in a specific way: Much like older coronaviruses known for causing the common cold, SARS-CoV-2 has a “remarkable capacity to cause repeat infections” by evolving to better dodge the frontline defences of the human immune system.
That means vulnerable individuals should treat the latest COVID vaccines like annual flu shots — not boosters — to ensure their immune system is primed to tackle new variants and avoid serious illness and lingering, life-altering health impacts, she said.
“We know that having COVID increases risks of heart attacks and other complications, especially in older adults,” Bowdish added.
“And importantly, if an older adult is hospitalized, it is very rare for them to leave the hospital and have the same level of function as they did before they went in.”
WATCH | What seniors need to know about this year’s fall vaccines:
Four key vaccines are available for seniors this fall, including an updated COVID-19 shot and Canada’s first vaccine for RSV. CBC health reporter Lauren Pelley breaks down what seniors — and those who care for them — need to know.
Public, policymakers face ‘COVID fatigue’
While the vaccine guidance for higher-risk groups is fairly straightforward, McGeer, in Toronto, said younger adults in their 20s and 30s may have more to consider as they weigh the risks and benefits.
The mRNA-based vaccines from Pfizer and Moderna have been linked to higher reactogenicity — referring to expected post-vaccination reactions caused by someone’s immune response, such as a fever or a sore arm — which can discourage some people from getting another shot, McGeer said.
Novavax’s protein-based, non-mRNA vaccine is now approved as well, and doses have been delivered to the Public Health Agency of Canada for distribution to the provinces, but McGeer said it likely won’t be as widely available, making it harder to access for many Canadians who want a more traditional option.
People are also trying to navigate complex vaccination advice on how to time their next shots, she added. Guidance suggests waiting six months or so after your last vaccination or infection before getting another dose, which can complicate efforts to roll out seasonal immunization campaigns, since Canadians are operating on various schedules based on when they were last exposed to the virus.
Then there’s the simple fact that so many people are tired of getting shot after shot, four years into the COVID pandemic.
“I think everyone has a little bit of COVID fatigue, including our policymakers,” said Bowdish. “And so we haven’t been as aggressive.”
COVID’s long-term trajectory still an ‘open question’
The medical experts who spoke to CBC News also didn’t paint a clear picture of what the future could hold for COVID vaccination efforts.
Tam said the door is still open for another spring vaccination push, though she noted uptake last spring was also relatively low. Bowdish, the immunologist, agreed twice-annual vaccines may be appropriate given how quickly this virus is evolving.
McGeer, however, said over the long term, as more people gain repeat exposure to this virus earlier and earlier in life, the need for COVID vaccines could start to shift. A twice-annual vaccine seems unlikely, “and I’m not sure that we’re even settling into an annual vaccine,” she said.
But the world won’t know for years, perhaps even decades, how this virus will evolve, what seasonal patterns it could settle into, and how those factors might change the risks of acute illness or lasting health impacts.
“How long that trajectory is going to take, and where it’s going to stop, [is an] open question,” McGeer said.